<form action="<?php echo base_url('User/AccountService/signUp'); ?>" method="post">

	<h1><?php echo $this->l('Create Your Account'); ?></h1>
    <?php include(((BASEPATH == '/')?'':dirname(BASEPATH)).'/'.APPPATH.'views/Templates/flashMessage.php'); ?>
	
	<div class="login-fields">
		
		<p><?php echo $this->l('You are a patient? Create your account.'); ?></p>
		
		<div class="field<?php echo (form_error('firstname'))?' error':''; ?>">
			<label for="firstname"><?php echo $this->l('First name:'); ?></label>
			<input type="text" id="firstname" name="firstname" 
                   value="<?php echo set_value('firstname'); ?>" 
                   placeholder="<?php echo $this->l('Enter your first name'); ?>" class="form-control" />
             
             <?php echo form_error('firstname', '<span class="error">', '</span>'); ?>
		</div> <!-- /field -->
		
		<div class="field<?php echo (form_error('lastname'))?' error':''; ?>">
			<label for="lastname"><?php echo $this->l('Last name:'); ?></label>	
			<input type="text" id="lastname" name="lastname" 
                   value="<?php echo set_value('lastname'); ?>" 
                   placeholder="<?php echo $this->l('Enter your last name'); ?>" class="form-control" />
             
             <?php echo form_error('lastname', '<span class="error">', '</span>'); ?>
		</div> <!-- /field -->
		
		
		<div class="field<?php echo (form_error('email'))?' error':''; ?>">
			<label for="email"><?php echo $this->l('Email Address:'); ?></label>
			<input type="text" id="email" name="email" 
                   value="<?php echo set_value('email'); ?>" 
                   placeholder="<?php echo $this->l('Enter your email'); ?>" class="form-control input-lg email-field"/>
             
             <?php echo form_error('email', '<span class="error">', '</span>'); ?>
		</div> <!-- /field -->
		
		<div class="field<?php echo (form_error('username'))?' error':''; ?>">
			<label for="username"><?php echo $this->l('Username:'); ?></label>
			<input type="text" id="username" name="username" 
                   value="<?php echo set_value('username'); ?>" 
                   placeholder="<?php echo $this->l('Enter your username'); ?>" class="form-control input-lg username-field"/>
             
             <?php echo form_error('username', '<span class="error">', '</span>'); ?>
		</div> <!-- /field -->
		
		<div class="field<?php echo (form_error('passwd'))?' error':''; ?>">
			<label for="passwd"><?php echo $this->l('Password:'); ?></label>
			<input type="password" id="passwd" name="passwd" 
                   value="<?php echo set_value('passwd'); ?>" 
                   placeholder="<?php echo $this->l('Enter your password'); ?>" class="form-control input-lg password-field"/>
             
             <?php echo form_error('passwd', '<span class="error">', '</span>'); ?>
		</div> <!-- /field -->
		
		<div class="field<?php echo (form_error('confirm_password'))?' error':''; ?>">
			<label for="confirm_password"><?php echo $this->l('Confirm Password:'); ?></label>
			<input type="password" id="confirm_password" name="confirm_password" 
                   value="<?php echo set_value('confirm_password'); ?>" 
                   placeholder="<?php echo $this->l('Confirm the password'); ?>" class="form-control input-lg password-field"/>
             
             <?php echo form_error('confirm_password', '<span class="error">', '</span>'); ?>
		</div> <!-- /field -->
		
	</div> <!-- /login-fields -->
	
	<div class="login-actions">		
		<button class="login-action btn btn-primary" name="btn_submit"><?php echo $this->l('Register'); ?></button>
		
	</div> <!-- .actions -->
	
</form>